Authorizations: System Alerts and Tracking

AgileEMR: System Authorization Alerts and Tracking

FEATURE PURPOSE: The system will provide a series of alerts to assist you in properly tracking a case's authorizations:

There are four alerts covered in this tutorial:

1. Insurance Page Alerts
2. Schedule Alerts
3. Work Queue Alerts
4. Case Home Page Alerts

1. Insurance Page Alerts

There are two different types of authorization statuses that will display in the authorization table for an Insurance Plan:

• Active – Coverage that has current dates of service or future appointments in the specified coverage date range
• Expired – Any coverage that no longer has current dates of services or future appointments  in the specified coverage date range 

There are multiple statuses that will display in the Authorization Status Bar for an Insurance Plan:

• Required before evaluation – displays in red warning that authorization should be entered prior to initial visit of case
• Required after evaluation, but before next visit – displays in red warning that authorization should be entered before second visit of the case.
• Separate authorizations are required for evaluation and treatment – displays in red warning that separate authorizations  are needed for the initial visit and second visit of the case.
• Remaining : X visits / days – displays in grey showing that the authorization is still active.
• Authorization expires after next visit - displays in yellow showing a warning that you may need to add an authorization soon.
• Authorization expires in 3 days – displays in yellow showing a warning that you may need to add an authorization soon.
• Authorization Expired – displays in red showing that the auth has expired.

Examples of these may be seen below:

To view rule that is being applied for authorizations at any time, hover over the Information Icon to the left of the Authorization Status bar.

If the calendar in the Authorization bar is red,  this is a visual queue that you will want to take a closer look.  You may view detail by pressing on the Calendar Icon.

Detail will show which Date of Services in that Insurance Coverage Authorization need to be addressed.  A status column displays the issue.   You may find explanations of these statuses below: 

• Billed – appointment was billed with a valid authorization
• Billed w/ Invalid Authorization – appointment was billed without an authorization number
• Acknowledged – appointment was acknowledged, but no charges were submitted yet
• Scheduled – appointment is scheduled, but not yet acknowledged

EXAMPLES:  The calendar alert above states that a previous date of service was billed without authorization. Once the date of service is rebilled the calendar will no longer be red.  Schedule appointments without authorization numbers assigned will also display in red until an authorization exists to cover them.

If past appointments cannot be corrected, you may select this checkbox below. This allows the system to no longer track older appointments that do not have a valid authorization, so when you open up this page, older appointment s  This alert will then be removed from view.

2. Schedule Alerts

If you schedule or check in a patient without authorization in the system, you will have to select a reason and enter a note as to why the patient was scheduled without proper authorization. This will be required for any patient appointment that is scheduled that does not have an authorization active for that date/visit.  A note will be added to the Case Home page.  

When a patient appointment is scheduled without authorization the patient’s name will show in red to alert there is no authorization on file.

A red alert message will also appear within the appointment pop-up when accessing the schedule.

3. Work Queue Alerts

There are 3 tasks for authorization in the work queue.

1. Auth Expired – shows as soon as current authorization expires if there are scheduled appointments.
2. Auth Expiring – authorization is going to expire is created when authorization is expiring in:
   • 3 Days OR 3 Visits
3. Auth Required – Authorization information has not been entered in the Authorization portion of the patient’s insurance screen.

You may easily work these Work Queue items by clicking the link directly into the Insurance Page of the Case.

4. Case Home Page Alerts

The following areas of the Case Home Page will serve as visual references for insurance page tracking of authorizations and allowed visits. Authorization alerts will display in red if the current authorization is expired.

1. Insurance Contract and Group number
2. Allowed visits per plan policy
3. Number of visits authorized
4. Date that authorization expires
5. Current Insurance Authorization
   • Number of visits used compared to authorized visits (i.e. 0 visits used of 4 authorized)
   • End date of insurance authorization

Case Account Notes

Below are examples of Case Account Notes (located within Home tab) that will be added when:

1. An appointment was acknowledged without an authorization.
2. An appointment was scheduled without an authorization.